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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OFF THE PROPERTY AND/OR FACILI'T'Y f <br /> LOCATED AT 63& '1 L—tNo`,0-� �c- <br /> (Street Address) , (City) <br /> HEREBY AUTHORIZE ' '� .� k,1�L <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If applicable) <br /> OWNER/OPERATOR: -TF..N B KOC 4L <br /> (Please Print) ("Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: �3� Lf L-4 N-P i�� S <br /> (Mailing Address) /� �y f <br /> S i �K-I11U �--t 1 �L' J <br /> (City) (States (Zip Code) <br /> PHONE: � Z� <br /> { jL� f <br /> EH 23 046 (Revised 10/16/03) Page 9 <br />